MEDICARE: MS. JODA HERRAN WEATHERSBY N.P., PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	RN484689 NP11635	CA
2	363LW0102X	Women's Health Nurse Practitioner	RN484689 NP11635	CA
3	364SC1501X	Community Health/Public Health Clinical Nurse Specialist	RN484689 CNS1319	CA

General Provider Information

NPI Number	:	1023158698
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JODA HERRAN WEATHERSBY N.P., PHD

Provider Business Mailing Address
First Line	:	PO BOX 1131
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92815-1131
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	241 N FIGUEROA ST RM 347
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90012-2601
Country	:	US
Telephone Number	:	213-240-8051
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	08/05/2009

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